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Pediatric Immunology and Allergy Diseases

Our defense system, called the ‘immune system,’ consists of many tissues, organs, and molecular elements that protect our bodies against microorganisms or harmful antigens. The response of the immune system to foreign antigens is called the ‘immune response.’ When the immune system unnecessarily exaggerates its response to harmless foreign antigens, it results in a condition known as ‘allergy.’

The Department of Pediatric Immunology and Allergy Diseases in hospitals examines immunodeficiency diseases that occur when any element constituting the immune system is missing or dysfunctional, in addition to allergic diseases.

Pediatric Immunology and Pediatric Allergy Subspecialty Pediatric immunology and pediatric allergy specialists complete their medical education for 6 years at the medical faculty and then choose their specialization branch according to their success in the medical specialization exam (TUS) and the available positions. After completing the 4-year training period of pediatric health and diseases specialty, they take the subspecialty exam (YDUS). They undergo a 3-year subspecialty training in the pediatric immunology and allergy diseases department according to the results of the exam.

When to Consult a Pediatric Allergy Doctor The most common diseases in childhood are atopic eczema, allergic rhinitis, allergic asthma, urticaria, food allergy, and anaphylaxis. The follow-up from the Pediatric Immunology and Allergy Diseases outpatient clinic is crucial, especially for patients with a history of anaphylaxis, a life-threatening allergic reaction commonly known as ‘allergic shock.’ In these cases, an emergency action plan should be established, necessary protection methods should be determined, and practical medication education should be provided to patients or their families. Many pediatric patients with recurrent cough complaints and bronchiolitis history, who require repeated hospitalization for inhalation therapy, have their asthma diagnosis confirmed in this department. About 30% of patients receiving eczema treatment also have accompanying food allergies, and local treatments cannot be successful because the responsible food is not removed from the diet.

Especially in cases where severe eczema needs to be investigated, immunodeficiency defects play a significant role among the underlying causes. Therefore, cases with severe eczema that do not respond to local or systemic treatments must be evaluated by the Pediatric Allergy Diseases Department.

In addition,

  • Frequent middle ear infections,
  • Upper or lower respiratory infections,
  • History of serious infections requiring hospitalization,
  • Constantly prescribed antibiotics,
  • Family history of immunodeficiency,
  • Late falling of the umbilical cord,
  • Onset of the disease after live vaccinations,
  • Presence of skin or organ abscesses,
  • Persistent thrush in the mouth,

must be evaluated for immunodeficiency. Delay in diagnosis and treatment occurs because these cases apply to different branch outpatient clinics. Therefore, awareness by both the physician and the patient is crucial.

Tests and Examinations Performed in the Pediatric Allergy Department The following tests are conducted for the diagnosis of allergic diseases:

  • Skin prick test (Allergy Skin Tests),
  • Patch test,
  • Specific IgE (allergy blood test),
  • Food Challenge Test (Oral provocation test)

Pulmonary function tests are guiding in patients aged 7 years and older with asthma diagnosis or suspicion. Radiological imaging methods can also be requested for the evaluation of non-allergic respiratory diseases.

History and physical examination are essential in evaluating the immune system. Initially, the patient is assessed with primary care tests. Complete blood count, immune antibodies (IgG, IgA, IgM, IgE), and vaccine responses may be useful for initial clues. Ultrasound may be requested for detailed examination when lymph node and spleen enlargement are detected during the physical examination of the patient. Depending on the patient’s clinic, advanced technology, immunology-specialized, experienced personnel evaluate immunological tests. Genetic analysis plays a crucial role in determining genetic deficiencies in severe immune system defects. It should be noted that the diagnosis is made by the physician based on the history taken, physical examination performed, and professional experience in the field. Tests are just requests that the physician uses to support the diagnosis. In many cases, there are discrepancies between the result of the test and the patient’s clinic. When the test results are evaluated by an allergy doctor specialized in allergy and immunology, it will be possible to make an accurate diagnosis.

Treatment Process in the Pediatric Immunology and Allergy Department The first step in the treatment of childhood allergy is to establish methods of protection from the responsible allergen. For pediatric patients with allergic asthma or allergic rhinitis, the necessary measures to avoid allergens should be declared with a list prepared by the physician. Avoiding allergens, reducing exposure to cigarette smoke, protecting against excessive cold, and regular exercise are recommended to avoid triggering factors.

Medical treatment should be arranged by selecting the appropriate treatment step for each patient. Drug education should be given to the patient’s relatives regarding medications used for asthma treatment. In addition to drugs that need to be used regularly, the actions to be taken in case of an attack should be explained. Different types of asthma are defined, and different terms are used according to the severity of the disease. After evaluating the patient’s current complaints, physical examination, and tests, treatment suitable for the phenotype and severity of asthma disease should be initiated.

Since attacks in patients with allergic asthma are triggered by respiratory allergens, elimination of the responsible allergen, regulation of environmental conditions, medical treatment, and allergen-specific immunotherapy (AIT) are applied.

Administration of Specific Immunotherapy (AIT) – Allergy Shots AIT, commonly known as allergy shots among the public, is the only treatment method that can change the course of the disease by inducing immune tolerance among the treatment modalities. The treatment option suitable for each patient should be arranged by a pediatric immunology and allergy diseases subspecialist physician according to regular follow-up and medical evaluation. AIT includes a treatment program that starts weekly and then transitions to monthly subcutaneous administration and lasts for 3-5 years. After obtaining consent from the patient’s family, it should be started. After completing a 2-hour observation period following the first dose in hospital conditions, the patient can go home after completing at least a 30-minute observation period following subsequent doses.

For cases where food allergies are detected, a diet form should be created for eliminating the responsible food, and the patient’s nutrition should be regulated in cooperation with a dietitian. In some cases, breastfeeding mothers need to follow a diet. Alternative foods should be selected according to the food they are dieting, if necessary, vitamin supplementation should be provided, and in cases where breast milk is insufficient, hypoallergenic formulas should be recommended.

The treatment of childhood allergy, when followed by doctors specialized in immunology and allergy with subspecialty training, significantly improves the child’s quality of life and allows them to continue their life with healthy growth and development.

What Is Immunodeficiency and How Is It Treated? Patients with primary immunodeficiency should be followed by doctors specialized in immune system diseases. Treatment varies according to the type of disease. Initially, infection prevention and general hygiene rules are essential for all patients. Live vaccine applications should be arranged according to the disease group. Revisions regarding vaccines must be communicated to the family physician responsible for following the patient’s vaccination program in writing. Long-term antibiotic and antifungal therapy may be necessary for some cases. In severe antibody deficiencies, intravenous Immunoglobulin (IVIG) replacement (substitution) constitutes the most critical part of treatment. IVIG was

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